Singapore 2017 Highlights

Highlights from Ophthalmology Futures Forums Singapore 2017

The second Ophthalmology Futures Asian Forum in Singapore was a success and attracted delegates, physicians, corporate leaders and investors from around the globe and from a wide spectrum of clinical and business specialties. Summaries of each of the seven panel discussions are highlighted below.

We are also grateful to Dr Flemming Ornskov, CEO of Shire for agreeing to provide a very insightful interview on his perspectives on innovation and Shire. A video of the interview can be viewed below.

> Beyond anti-VEGFs: Surviving the injections

Highlights:

Anti-vascular endothelial growth factor (VEGF) therapy remains a major success story in the treatment of retinal disease. Current agents are effective and “hard to beat”.

New agents should modify and alter disease cause or treat only markers of disease activity (eg. VEGF levels), rather than treat visual symptoms or optical coherence tomography signs.

There are no ideal animal models for retinal angiomatous disease or macular oedema, challenging the drug discovery pipeline. Multiple animal models need to be used.

There is an opportunity for greater commercialisation in ophthalmology. Few academics commercialise their research so greater incentives are required for academics to commercialise.

The opportunity for technology transfer varies globally. Israel and Singapore are advanced ecosystems, while countries in which English is not widely used are at a disadvantage with respect to globalisation.

Singapore is a good location for technology transfer. Intellectual property, funding and governmental support are well-developed. However, private sector involvement is lacking.

Leopold SchmettererProfessor of Ophthalmology and Head of Ocular Imaging, Singapore Eye Research Institute, Singapore

Theodore TanManaging Director, The Biofactory, Singapore

> The Asian investment climate

Highlights:

The Asian and South East Asian ophthalmology investment ecosystem is still nascent, but is promising. There is an increasing number of venture capitalists, strategics and investors who are interested in this space.

Opportunities and interest exist in both medical device and therapeutics, with no preference for either.

As part of the financing strategy, companies with relatively more mature technology (e.g. from the United States or Europe) could explore the use of local partnerships in order to access large, underserved Asian markets that have similar clinical needs.

Despite the significant number of glaucoma patients in Asia, the availability of new glaucoma devices in Asia is limited. The regulatory environment for these devices may be challenging in certain countries e.g. China.

The significant cost of new glaucoma devices and technologies may be prohibitive for most Asian glaucoma patients, as the reimbursement climate in Asia differs from the West and most patients are self-financed.

Many Asian glaucoma patients present with advanced glaucoma, and may not be suitable candidates for certain micro-invasive glaucoma surgery devices which are less appropriate for patients with advanced glaucoma.

The most important factor that has prevented widespread uptake of femtosecond laser-assisted cataract surgery in Asia is the cost, which is often perceived to outweigh the potential benefit.

Cost is also a major obstacle to the use of premium intraocular lenses in Asia, as most patients are self-financed.

Other barriers to the adoption of these new premium services include the lack of patient awareness / demand, extended chair-time due to the need for extensive pre-operative counselling and limited access to training for the ophthalmologist.

Co-chairs:

David ChangClinical Professor, University of California, San Francisco, USA

Soon-Phaik CheeSenior Consultant and Head of Cataract and Ocular Inflammation and Immunology Service, Singapore National Eye Center, Singapore

The development of new anti-microbial agents is hampered by the tremendous cost involved in drug development, the difficult regulatory pathway and the existence of much cheaper and effective alternatives.

Despite the increasing prevalence of systemic and ocular fungal infections both in Asia and globally, anti-fungal agents are limited. New anti-microbial agents are also needed to combat drug-resistant microbes.

The high prevalence of ocular infections in Asia makes it an ideal setting to conduct trials which study the pathogens and investigate the effect of anti-microbial agents.

In order to bring about a revival in the refractive market, improved patient education and experience is required to raise awareness about the safety of refractive surgery. There is also an opportunity in emerging markets (many of which are in Asia) to improve on this as economies are developing.

Training in refractive surgery is lacking in residency programmes, and it is only taught during fellowship. Improving the understanding of refractive surgery will improve its efficacy and therapeutic value, and reduce complications in the long-term.

New technologies, including SMILE and Contura, can help re-invigorate the market, but it is important to ascertain the safety of any new procedures in this precocious market.